Surgery - retro-sigmoid versus translab approach

[LizH]

What are the advantages of the retro-sigmoid approach as opposed to the translab approach in surgery? I don't really care about preserving my hearing but my facial nerve. I am worried about facial nerver damage during surgery. Thanks.

[Debbi]

Hi LIz-

First, this is only my opinion as a patient -- I chose translab because my surgeons said that it had a slightly better chance for preserving my facial nerve AND there was virtually NO chance of preserving my hearing with retro-sigmoid anyway.  Like you, I was more concerned with my facial nerve than with hearing.  I'm a little more than two weeks post surgery now, and do have some facial probelms, but am assured that they will resolve with a little time.  So far,I can't really say that the SSD has bothered me a great deal, but in fairness, it hasn't been long enough yet.

One thing I'd suggest, if you haven't already done it, is have a specific conversation with your surgeon/s about the pros and cons of both surgeries for YOUR particular case.  I asked a lot of questions and it really helped me to make the right decsion for me. 

And, feel free to ask questions here on this forum, too - I think you'll find eveyrone here very willing to share their experiences.  Just remember to make your own decsion.

Warmly,
Debbi

[wendysig]

Hi Liz -

I agree with Debbi.  I haven't had my surgery yet, but have discussed the different approaches in detail with my neurotologist.  If you have decent hearing, the retrosigmoid approach gives you a decent chance of preserving it, depending on the position and location of your tumor, but there is a higher possibility of temporary facial paralysis 2 -12 months according to my doctor.  Translab sacrifices your hearing outright, but provides a better preservation rate fot the facial nerve.  Hope this helps.

Wendy

[wendysig]

Liz -

Sorry, I just wanted to add a couple of things to my post above.  According to what I've learned,  retrosigmoid also has a slightly higher risk  of CSF leak so you might want to consider that as well.  I also just wanted to say too, that I am not a doctor and I can't givet medical advice, just information I'm passing on.  That is best gotten from your own doctor.  I doin't know about your doctor, but mine appreciated the fact that I did my homework and could therefore have an intelligent conversation with him, rather than his just talking at me.  This forum is a fountain of information and the people here are great , but if you'd like to do some more reserarch on your own, the internet has tons of information on ANs and their treament.  Just go to google.com and type in acoustic neuromas and their treatment.  You'll be amazed at what pops up.

Best wishes,

Wendy

[Syl]

Liz,
Retrosig is done with the attempt of saving your hearing. I'm told that generally translab has a lower risk of damage to the facial nerve. But, two Drs have told me that in their experience, the outcome to the facial nerve is about equal with those two procedures.

But also take into account that the larger the tumor, the larger the risk of damage to the facial nerve. Yours is on the larger side.
The only gurarantees with surgery is that translab leaves you deaf on the AN side.  It's not an easy decision, I know. I thought my mind was made up to have translab, but I saw one more dr. and am now reconsidering retrosig.

Good luck with making your decision and I'll pray for a positive outcome with it.

Syl

[LizH]

Thanks for your response everyone.
Wendy, I have done my research but I also wanted to hear from patients!

[leapyrtwins]

LizH -

I had retrosigmoid almost a year ago.  I have no facial nerve damage, I had no CSF leak.  I do have SSD in my AN ear, but my tumor had grown and wrapped itself around my hearing nerve.  In order to remove the entire tumor, the docs destroyed my hearing nerve - which in my opinion, they should have.  I wholeheartedly agree with their decision.

Like others have said, everyone is different.  As you know, your doc will tell you what side-effects you can possibly be left with, but you won't know which ones (if any) you will have until post op.

There are no guarantees with ANs or their treatment.

Keep in mind that facial nerves have the ability to regenerate over time, so many times facial nerve damage isn't permanent.

Good luck with your surgery,

Jan

[Jim Scott]

Hi, Liz: 

Sorry I'm late to the thread.  Busy day. 

I had the 'Retrosigmoid/Suboccipital Approach' surgery (which uses mirrors) because my neurosurgeon said that gave him the best access to my AN.  That seemed reasonable to me.  Like you, I was deeply concerned about facial nerve damage and made that very clear to my doctor.  I'm pleased to report that I suffered no facial nerve damage and experienced no CSF leaks.  Of course, the neurosurgeon employed nerve monitoring during my surgery.  He 'debulked' the AN (cut it down so it was small enough to radiate).  The subsequent FSR treatments I underwent (to stop the tumor's growth and destroy it's DNA) were also successful and again, I did not experience facial nerve damage.  Now, just about two years post-op, I'm fine. 

Translabyrinthine is probably more 'popular' with many surgeons because, not only is it the oldest procedure, but it offers a direct view of the facial nerve.  Unfortunately, 'Translab'  does sacrifice hearing - but it offers a good chance for preservation of the facial nerve.  I think we have to realize that the size and location of the AN is critical to what approach the surgeon will use.  'Translab' is usually considered best for facial nerve preservation, 'Retro' and Middle Fossa surgical approaches have some success in preserving hearing in the AN-affected ear.  My hearing was already lost before my AN was discovered but, as I've stated, my neurosurgeon used the 'Retro' approach as a practical matter (better access) and my surgery came out just fine.  I hope whatever approach you chose will have similar results. 

Jim

[robynabc]

HI,

Just wanted to let you know what we found out about Retro vs. Translab.  When my son was dx with a 4.5+ I had to research and one doctor was very adamant that we should do translab and completely disagreed with the retro that our docs wanted to use.  He said that our sons hearing was gone so translab was the best for facial nerve. So I called our neurosurgeon and asked him about it he said he preferred translab because of the brainstem issue.  Eric's brainstem was really, really compressed.   I told him I had heard that there were more headaches with retro.  He said he didn't think that was true but way less SF leaks with retro.  He preferred it.  I personally think it may depend on brainstem issues.  If it were me with a large tumor I would think retro would be preferred.    It worked well for us and Eric had no facial paralysis with complete removal.  His only issue is a vocal cord and coughing issue.  Hope that helps. 

[wendysig]

Hi Liz -

Hope I didn't offend you.  I thought you probably had but I was just trying to be helpful.  Good luck with your choice.  I hope whatever it is, you are as comfortable as you can be with it and have a great outcome.  I will keep in touch.

Best wishes,

Wendy

[calimama]

Hi Liz...

Both of the surgeons who i spoke to indicated they would do retrosig for me because of 1. the location (in the CP angle) and 2. chance, albeit small, to preserve my hearing (i still have about 70%). I think they are many factors and in the end, the surgeon will be doing the operation so they must be comfortable (and hopefully you too!) to make a decision in this.  I guess in some cases it is a 'no brainer'    as to which approach is best, in other cases in may depend on the surgeon, patient, and circumstances.

Good luck.

Trish